A year's experience with a mobile coronary resuscitation unit

A mobile unit for the emergency treatment of cases of coronary thrombosis in the patient''s home and for their supervised conveyance to hospital has been operating in the City of Newcastle upon Tyne for a year. In that time 134 cases have been attended, and of these 39 benefited appreciably from use of the unit. The value of such a unit must be balanced in relation to the current mortality of the disease outside and inside hospital and the staff available     

Comparative Effectiveness of Different Forms of Telemedicine for Individuals with Heart Failure (HF): A Systematic Review and Network Meta-Analysis

BackgroundPrevious studies on telemedicine have either focused on its role in the management of chronic diseases in general or examined its effectiveness in comparison to standard post-discharge care. Little has been done to determine the comparative impact of different telemedicine options for a specific population such as individuals with heart failure (HF).LimitationsMuch of the evidence currently available has focused on the comparing either telephone support or telemonitoring with usual care. This has therefore limited our current understanding of how some of the less common forms of telemedicine compare to one another.ConclusionsCompared to usual care, structured telephone support and telemonitoring significantly reduced the odds of deaths and hospitalization due to heart failure. Despite being the most widely studied forms of telemedicine, little has been done to directly compare these two interventions against one another. Further research into their comparative cost-effectiveness is also warranted.     

Principal component analysis in combination with case-based reasoning for detecting therapeutically correct and incorrect measurements in continuous glucose monitoring systems

This paper introduces a data-driven methodology for detecting therapeutically correct and incorrect measurements in continuous glucose monitoring systems (CGMSs) in an intensive care unit (ICU). The data collected from 22 patients in an ICU with insulin therapy were obtained following the protocol established in the ICU. Measurements were classified using principal component analysis (PCA) in combination with case-based reasoning (CBR), where a PCA model was built to extract features that were used as inputs of the CBR system. CBR was trained to recognize patterns and classify these data. Experimental results showed that this methodology is a potential tool to distinguish between therapeutically correct and incorrect measurements from a CGMS, using the information provided by the monitor itself, and incorporating variables about the patient's clinical condition.     

Prehospital Thrombolysis: A Manual from Berlin

In acute ischemic stroke, time from symptom onset to intervention is a decisive prognostic factor. In order to reduce this time, prehospital thrombolysis at the emergency site would be preferable. However, apart from neurological expertise and laboratory investigations a computed tomography (CT) scan is necessary to exclude hemorrhagic stroke prior to thrombolysis. Therefore, a specialized ambulance equipped with a CT scanner and point-of-care laboratory was designed and constructed. Further, a new stroke identifying interview algorithm was developed and implemented in the Berlin emergency medical services. Since February 2011 the identification of suspected stroke in the dispatch center of the Berlin Fire Brigade prompts the deployment of this ambulance, a stroke emergency mobile (STEMO). On arrival, a neurologist, experienced in stroke care and with additional training in emergency medicine, takes a neurological examination. If stroke is suspected a CT scan excludes intracranial hemorrhage. The CT-scans are telemetrically transmitted to the neuroradiologist on-call. If coagulation status of the patient is normal and patient''s medical history reveals no contraindication, prehospital thrombolysis is applied according to current guidelines (intravenous recombinant tissue plasminogen activator, iv rtPA, alteplase, Actilyse).Thereafter patients are transported to the nearest hospital with a certified stroke unit for further treatment and assessment of strokeaetiology. After a pilot-phase, weeks were randomized into blocks either with or without STEMO care. Primary end-point of this study is time from alarm to the initiation of thrombolysis. We hypothesized that alarm-to-treatment time can be reduced by at least 20 min compared to regular care.     

Life Cycle Assessment of the Mobile Communication System UMTS: Towards Eco-efficient Systems (12 pp)

Goal, Scope and Background Goal of this study is an evaluation of the environmental sustainability of the UMTS mobile communication system in Switzerland by means of a Life Cycle Assessment (LCA). A baseline environmental impact profile across the full life cycle of the UMTS (Universal Mobile Telecommunication System) and its predecessor, the GSM (Global System for Mobile Communication) is presented. The baseline assessment was a necessary first step to evaluate the environmental impacts of the mobile communication systems use and growth, thus permitting the evaluation of its environmental sustainability. Main Features Two functional units are defined: a data set of 1 Gbit (1.000.000 kbit), and the yearly mobile communication of an average customer. In the UMTS, both data packages and calls can be conveyed. In order to be able to standardize the results, an equivalence between these two kinds of transmission is formed. Two different options are defined, which represent different ways of transferring the data: mobile phone to mobile phone, and mobile phone to fixed network. All components of the UMTS network like the mobile phones, base stations, antennae, switching systems and the components of the landline like cable system and switching centers, are assessed. The environmental impacts are assessed taking into account all major life cycle phases like raw material extraction, manufacturing, use, disassembly and disposal of the product and the needed infrastructure. Electronic components like printed wiring boards and integrated circuits are assessed using a simple model based on the size (for IC) or number of layers (for PWB), respectively. Mining of precious metals (gold, silver) is included. The study was carried out by ESU-services, Motorola, Swisscom and Deutsche Telekom. Thanks to the industrial partners it can rely on primary data for the production of mobile phone and base station, and for the operation of the networks. As the UMTS network is still being built, no actual data of network operation is available. Data from the GSM (Global System for Mobile Communication) were used in case of data gaps. Results and Conclusions About 25 kg CO2 are emitted and 800 MJ-eq (non-renewable) primary energy are required for the transfer of 1 Gbit information from mobile phone to mobile phone in the UMTS network. For a transfer from mobile to fixed network, these values are 20 kg CO2 and 640 MJ-eq, respectively. On the other hand, the fixed network requires more resources like copper (0.07 kg for the mobile to mobile option vs. 0.12 kg for mobile to fixed network). From an environmental point of view, the mobile telephone is the most important element of the mobile communication network (UMTS and GSM). The short service life of the mobile phone plays a substantial role. Increasing the utilization period of the mobile phone (e.g. by leasing, re-use, extension of the innovation cycles, etc.) could thus represent a large potential for its improvement. The second most important components are the base stations. In the assessment mainly the use phase proved to be important. The lower environmental impact (per Gbit data transfer) as compared to the mobile phone can be explained by the longer service life (around factor 8). Main impacts are caused by the electricity consumption, in particular the energy needed for cooling the base stations. By choosing an environmentally benign electricity mix and/or by increasing the portion of renewable sources of energy, the network operators have a substantial potential of lower the environmental impacts (in particular the greenhouse gas emissions) of mobile telecommunication. Furthermore, the manufacturing of electronic components, the life time of the appliances and energy consumption are key parameters influencing the environmental profile of the networks most. Given its larger data transfer rate, the UMTS is ecologically more favorable in terms of data transfer rate than its predecessor, the GSM system. The higher energy consumption and the more complex production of the devices in the UMTS system are compensated by the faster data transmission rate. Per customer, the result is inverse, however, since the higher efficiency is compensated by the higher data communication per user in the UMTS system. The UMTS network in its state of 2004 according to the 2001 planning and with the accordingly calculated number of customers and data transfer causes 2.1 times more CO2 emissions and requires 2.4 times more (non-renewable) primary energy per customer than for the GSM system in its current state. It must be noted, however, that the UMTS technology supports other services than the GSM system. The development of the UMTS is accompanied with an increased consumption of resources and emissions of pollutants and greenhouse gases regarding the entire system for mobile telephone communication. The GSM system is a mature technology, while the UMTS is still at the beginning of its learning curve. Thus, it can be safely assumed that large improvement potentials are still present for the UMTS network components concerning expenditures and emissions both at production and by the use of the devices. This study provides the necessary information where such improvements are most effective in environmental terms.     

Automated sleep breath disorders detection utilizing patient sound analysis

Results of clinical studies suggest that there is a relationship between breathing-related sleep disorders and behavioral disorder and health effects. Apnea is considered one of the major sleep disorders with great accession in population and significant impact on patient's health. Symptoms include disruption of oxygenation, snoring, choking sensations, apneic episodes, poor concentration, memory loss, and daytime somnolence. Diagnosis of apnea and breath disorders involves monitoring patient's biosignals and breath during sleep in specialized clinics requiring expensive equipment and technical personnel. This paper discusses the design and technical details of an integrated low-cost system capable for preliminary detection of sleep breath disorders at patient's home utilizing patient sound signals. The paper describes the proposed architecture and the corresponding HW and SW modules, along with a preliminary evaluation.     

Diagnostic and therapeutic assessment by telephone electrocardiographic monitoring of ambulatory patients.

The electrocardiograms of ambulatory patients have been monitored over the telephone by staff of the intensive cardiac care unit using equipment in the unit. Telephone monitoring is a useful way of diagnosing transient symptomatic arrhythmias and a reliable aid in supervising the patient''s rhythm at the beginning or end of treatment. The doctor has direct contact with the patient at the time of his symptoms so that he can reassure or instruct him. This system costs relatively little in manpower and equipment and permits relatively long periods of follow-up. It is effective, however, only in symptomatic cases in which the rate or rhythm disturbances last long enough to be transmitted. Also important are the negative findings when the patient complains of symptoms and abnormal findings during routine telephone transmissions. Accurate detection of transient ischaemic changes seems to be less reliable, and further technical improvements are required.     

Chest Radiography in Intensive Care Units

The role chest radiography plays in intensive care units (ICU) is unlike its role elsewhere because in the ICU a patient''s underlying disease is usually known. Furthermore, additional diseases that develop in the ICU—such as pneumonia, hemorrhage, edema, lung collapse and effusion—often are radiographically indistinguishable. Nevertheless, an ICU radiograph of the chest is valuable, mainly in identifying such complications as malpositioned intravenous catheters, Swan-Ganz catheters, pacemakers, nasogastric tubes, endotracheal tubes, chest tubes, and mediastinal tubes, and ectopic gas related to mechanical ventilation. Understanding the limitations of the portable ICU chest film in the diagnosis of specific diseases and being alert to possible iatrogenic complications will increase the usefulness of ICU chest radiography.     

Postal survey of patients' satisfaction with a general practice out of hours cooperative.

OBJECTIVE: To assess patients'' satisfaction with out of hours care by a general practice cooperative compared with that by a deputising service. DESIGN: Postal questionnaire survey. SETTING: A general practice cooperative in London and a deputising service operating in an overlapping area. SUBJECTS: Weighted samples of patients receiving telephone advice, a home visit, or attending a primary care centre after contacting either service in an eight week period. MAIN OUTCOME MEASURES: Patients'' overall satisfaction and scores for specific aspects of satisfaction. Satisfaction with telephone advice or attendance at centre compared with home visit. Relation between satisfaction and patient''s age, sex, ethnic group, car ownership, preference for consulting own doctor, and expectation of a visit. RESULTS: The overall response rate was 67% (1555/2312). There was little difference in overall satisfaction between patients contacting the cooperative or the deputising service, but patients contacting the latter were less satisfied with the explanation and advice received and the wait for a visit. There were significant differences between patients in different age and ethnic groups, with white patients and those aged over 60 years being more satisfied. Lower scores for overall satisfaction were reported by patients who received telephone advice, those who would have preferred to see their own doctor or who originally wanted a home visit, and those who waited longer for their consultation. Overall levels of patients'' satisfaction seemed to be lower than previously reported. CONCLUSIONS: There were larger differences in satisfaction between different groups of patients than between different models of organisation for out of hours care. A shift to a service based predominantly on telephone advice may lead to increased patient dissatisfaction.     

Teleconsultation with the mobile camera-phone in digital soft-tissue injury: a feasibility study

The purpose of this study was to examine the feasibility of teleconsultation using a mobile camera-phone to evaluate the severity of digital soft-tissue injury and to triage the injury with regard to management recommendations. With a built-in 110,000-pixel digital camera, pictures of the injured digit(s) or radiograph were taken by surgical residents in the emergency room and transmitted to another camera-phone to be viewed by the remote consultant surgeon. A brief medical and trauma history of each patient was relayed also by mobile phone. The consultant surgeon then reviewed all of these patients in the emergency room shortly after the initial telemedicine referral. Separate triaging for each digital injury into three groups was recorded during remote teleconsultation and according to actual treatment by the attending surgeon as follows: group I, the injury could be managed with conservative treatment, such as secondary intention wound healing, or primary closure with or without bone shortening; group II, skin grafting or local flap coverage was required for management of the injury; and group III, microsurgery such as replantation or free flap coverage was necessary to deal with the injury. Later, triaging was also performed individually by three junior plastic residents according to image review and patient referral information. Teleconsultation through a mobile camera-phone was performed for 45 patients with injuries of 81 digits from January to May of 2003. Of these 81 digital injuries, there were 12 cases (15 percent) where disagreement of triaging occurred between the teleconsultation and the actual treatment by the attending surgeon. In image reviewing, there was 79 percent sensitivity and 71 percent specificity in remote diagnosis of the skin defect and 76 percent sensitivity and 75 percent specificity in remote identification of the bone exposure regarding the concordance of opinions of all three surgeons; there was significant discordance in triaging in 20 cases (25 percent), and the difference in triaging was partly attributed to the inability to show instances of tiny exposed digital bone or tendon in some cases under the low-resolution digital image and the situation of a bloody oozing wound. In some cases, the difficulty in evaluating the probability of primary closure of severely avulsed skin edges or the probability of executing replantation for finger amputation also contributed to different triaging outcomes. Two neglected diagnoses of transected digital nerves were found and influenced triaging, highlighting the importance of on-site physical examination during teleconsultation. The telemedicine system using a mobile camera-phone based on the global system for mobile communication is feasible and valuable for early diagnosis and triaging of digital soft-tissue injury in emergency cases, with on-line verbal communication and review of the transmitted captured image. This system has the advantages of ease of use, low cost, high portability, and mobility. With advances in hardware for digital imaging and transmission technology and the development of the third-generation advanced mobile phone system in the foreseeable future, this system has potential for future applications in telemedicine and telecare.     

Support of prevention medicine techniques with the help of telemedical monitoring]

Prevention medicine should not be limited to regular preventive diagnosis in a prevention center. Expecially for patients with a known increased risk a mobile telemonitoring would be benefitial. This telemonitoring continuously measures certain vital parameters, detects negative changes or even acute risks with an inbuilt intelligence (smart sensor) and sends alarm messages to the prevention center. This paper presents firsts products already available on the market, analyses weaknesses and draws a scenario of a future telemedical system for preventive purposes. One focus is the development of mobile hubs, that provide the communication with the mobile sensors and that at the same time allow a tracking or positioning of the patient.